The Dermatology Times is running an article highlighting the novel and unlikely rosacea treatments based on a nasal decongestant and a glaucoma treatment.

They of course are referring to Oxymetazoline and Brimonidine.

The article mentions the positive results from the “most recent research” on Brimonidine ;

In the most recent research, a double-blind study for Galderma, a 1 g application of 0.18 percent COL-118 facial gel (1.8 mg brimonidine) was administered topically in the morning; a second, four hours later. The erythema began decreasing within an hour, and the results lasted most of the day.

Almost suggesting that the real success of Sansrosa is it’s placebo effect are the following comments ;

Dr. Leyden describes the redness as significantly reduced when the brimonidine is applied, and he says that patients are thrilled with the results.

“They’re ecstatic. They know the result isn’t permanent and will wear off in a matter of hours, but just the fact that redness can be controlled is more than what they have had,” Dr. Leyden tells Dermatology Times.

While there is no medical reason for the preparation to have a lasting effect on a patient’s basic rosacea erythema, Dr. Leyden says some improvement can often be seen in that baseline redness.

“It may be because stress is one of the contributing factors in rosacea. Once the patient knows there is a way to reduce the redness, they worry less about a flare-up, and the base redness decreases as a result,” he says.

Whilst is it fine to state that the method of operation is unknown, claiming a drug’s success is psychological is a little concerning. Whilst the placebo effect is well known and somewhat understood, it naturally doesn’t form any solid basis for a product’s success. One has to ask whether the product will be universally successful across the population if an important part of the treatment is the belief that it will work. Having said all this, it might just be a throw away line, as indeed double-blind placebo-controlled trials are designed to prove that the active agent is effective.

“I would caution patients with rosacea not to go out and apply straight Afrin on their skin. Afrin contains several ingredients that can be irritating. But the ingredients used in Afrin do show signs of offering a breakthrough in rosacea treatment in the future,” she says.

We also know from the Feb. 2008 meeting of the AAD that oxymetazoline is effective for up to 6 hours after application, and that no negative side effects have been seen after 3 months usage.

I think the point is that these two products were originally for a runny nose and a chronic eye disease – and thus it is quite surprising that they might be effective in treating rosacea.

Neither is currently officially approved as a treatment for rosacea, so one could also say that their release as a treatment is unlikely – but that seems counter to the good results and trials underway.

So the use of unlikely here refers to the surprising fact that afrin or alphagan-p might lead to new rosacea treatments.

Clearly whoever wrote this article doesn’t understand the condition well if they attribute the products longer lasting benefit to a placebo effect. Rosacea is notorious for going through stages of clearance and aggravation. No doubt the use of San Rosa would help calm inflammation causing the redness. Anyone can attest that after a week with relatively little flushing your rosacea looks great.

Indeed it is curious wanting to claim that the placebo effect should be credited for good results. The trouble is that the placebo effect as been proven to be quite powerful. Add to the mix the fact that some inactive vehicles are beneficial on their own, and you get a statistical nightmare. You are also right to mention the fact that rosacea for many is episodic – it can be difficult to match flareups with a list of triggers let alone with improving after any particular treatment.

Hence the need for double blind trials – to statistically prove that an active agent is the reason for any benefits seen. They take ages and are very expensive but they are one of the main tools to get through the FDA, so we are stuck with them.